Suicide-Related Internet Searches During the Early Stages of the COVID-19 Pandemic in the US

This cross-sectional study assesses trends in suicide-related internet search rates in the early stages of the COVID-19 pandemic in the US.


Introduction
Experts anticipate that the societal fallout associated with the coronavirus disease 2019 (COVID-19) pandemic will increase suicidal behavior, and strategies to address this anticipated increase have been woven into policy decision-making without contemporaneous data. 1,2For instance, President Trump cited increased suicides as an argument against COVID-19 control measures during the first presidential debate on September 29, 2020.
Given the time delays inherent in traditional population mental health surveillance, it is important for decision-makers to seek other contemporaneous data to evaluate potential associations. 3To assess the value that free and public internet search query trends can provide to rapidly identify associations, we monitored suicide-related internet search rates during the early stages of the COVID-19 pandemic in the US.

Methods
In this cross-sectional study, we replicated the methods of a previous study on tracking suicidal ideation. 4Weekly Google search rates (per 10 million searches) for the term suicide after excluding searches mentioning squad (a reference to a popular film) that originating from the US between January 1, 2010, and July 5, 2020, were monitored using the Google Trends application programming interface (Alphabet Inc).We also monitored the top 20 unique queries related to suicide after unrelated terms (eg, suicide slide) had been excluded.This study was exempted from ethical review and certified as not qualifying as human participant research by the University of California San Diego Human Research Protections Program.This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.Changes in search rates were compared before and after the US declaration of a national emergency for the COVID-19 pandemic during the second week of March 2020.Search rates between January 1-7, 2010, and March 1-7, 2020, were used to forecast expected search rates between March 8-14, 2020, and July 5-12, 2020, using an autoregressive integrated moving average model.The ratio of observed and expected search rates with bootstrapped 95% CIs was computed weekly and cumulatively.Absolute volume of searches was estimated by multiplying the search rates by total search estimates from comScore.com(comScore Inc).Analyses were performed using R, version 3.6.1 (R Project for Statistical Computing)

Results
All queries containing the term suicide cumulatively decreased by 22% (95% CI, 18%-26%) in the 18 weeks after President Trump declared a national emergency and never eclipsed their expected search rate for any week (Figure 1).In raw terms, this was approximately 7.8 million fewer searches than expected.

Discussion
Internet searches for suicide, previously found to be associated with population changes in suicidal behavior, 3,5 decreased during the early stages of the COVID-19 pandemic in the US.Although this study cannot independently confirm that changes in search rates were caused by changes in population-level suicide rates, it showed that COVID-19 may have been inversely associated with population suicide trends between March and July 2020.Counter to expectations, our early findings are supported by the literature on catastrophic events. 6In some cases, catastrophes are associated with increased social support and unify communities and are thereby associated with reduced suicidal outcomes (what experts call the "pulling together" phenomenon).These include acute events, such as the 1995 Great Hanshin-Awaji Earthquake, and long-lasting events, such as the

Figure 1 .
Figure 1.Suicide-Related Internet Searches During the COVID-19 Pandemic in the US from July 2019 through July 2020